Search

In the wake of COVID-19, study conditions in Europe have changed dramatically. To limit contact between students and teachers, since March 2020 teaching has largely taken place digitally (remotely via digital means) and in private. Because the success of digital learning likely relies on many factors beyond good digital infrastructure conditions, this article focuses on which aspects, at both the teacher and the student levels, promote digital learning success. The large-scale student survey “Studying in Times of the Corona Pandemic” conducted at German universities and universities of applied sciences in the summer semester of 2020 offers data on how COVID-19 has affected several aspects of university studying in Germany. Here, we consider this data within the theoretical framework “theory of transactional distance” introduced by Moore (in: Moore (ed) Handbook of distance education, Routledge, 2018), according to which the success of digital teaching is influenced by dialogue, structure, and learner autonomy. Based on various regression analyses, our results show that several (digital) framework conditions must be created on both the teacher and student levels to achieve sufficient digital learning success. In this sense, our findings provide guidance on which aspects institutions of higher education should focus on when developing or updating their digitalization strategies. In accordance with collaborative learning approaches a key factor for learning success appears to be enabling peer-to-peer interactions. This finding supports our prediction that the possibility of engaging in interactive learning activities is crucial for students’ learning experience, as it might reduce the perception of transactional distance and allow for social exchange. The strongest predictor of students’ learning success turned out to be the (perceived) digital competencies of the teachers. This finding clearly emphasizes that teachers must be qualified to address the very specific challenges of teaching in digital contexts and indicates that universities may need to implement more teacher qualification programs.

This paper investigates the links between poverty and marital separation. In order to account for both unobserved heterogeneity and complex dynamics, the paper builds and estimates a dynamic nonlinear panel model with correlated random effects. The main finding is that a substantial portion of the link between poverty and separation appears to derive spuriously from unobserved factors that affect both outcomes. However, even after accounting for dynamics and unobserved heterogeneity, there remains a strong association between the arrival of poverty and marital separation. The results appear to suggest that poverty and separation often arrive concurrently, though that finding might stem from the relatively course periodicity of large micro household panel surveys. To that end, this paper presents a case for household surveys to adopt more frequent recordings of information.

Transoral Robotic Surgery (TORS) is increasingly used for oropharyngeal neoplasms and obstructive sleep apnea. Post-operative pain and bleeding remain concerns. Ketorolac has proved to be a safe alternative or addition to narcotics in other operations, but has not been thoroughly evaluated in TORS. A retrospective review was carried out on all TORS cases at our institution between April 2012 and March 2019, with the vast majority of cases performed starting in 2017. Post-operative bleed rates were compared between those who received Ketorolac and those who did not. Secondary outcomes evaluated included post-operative pain scores and need for feeding tube upon discharge. A total of 81 TORS cases were evaluated, with 37 patients receiving Ketorolac. Six (7.4%) patients reported post-operative bleeding, with one major and five minor bleeds. The patient with major bleeding requiring operative intervention did not receive Ketorolac. All five patients with minor bleeding received Ketorolac, but no bleeds occurred in the immediate post-operative setting while receiving Ketorolac. The average time of bleeding was 8 days post-operative. There were no significant differences in pain scores or time to feeding tube removal. This preliminary study shows that Ketorolac use in the postoperative pain management after TORS does not increase major bleeding risk without benefits in pain management. There was increased risk of minor bleeding not requiring intervention, but this was not significant. Future prospective studies are needed to determine if it improves pain and swallowing and decreases narcotic requirements following TORS.

As a key endocrine axis involved in responding to stress, the hypothalamic–pituitary–interrenal axis plays dual roles in mobilizing energy and maintaining ionic/osmotic balance in fishes. Although these roles have been examined independently in detail in adult fishes, less attention has been paid to the effects of an endogenous stress response during early life, particularly with respect to its potential effects on ionic/osmotic balance. The present study tested the hypothesis that exposure of zebrafish to stress during early development would alter ion balance later in life. Zebrafish at three developmental stages (4, 7, or 15 days post-fertilization, dpf) were subjected to an air-exposure stressor twice a day for 2 days, causing elevation of whole-body cortisol levels. Individuals stressed early in life exhibited decreased survival and growth, altered cortisol responses to a subsequent air-exposure stressor, and increased whole-body Na+ and Ca2+ concentrations. Changes in whole-body Ca2+ concentrations were accompanied by increased ionocyte abundance at 7 dpf and increased rates of Ca2+ uptake from the environment. Differences in whole-body ion concentrations at 15 and 35 dpf were not accompanied by altered ion uptake rates. Across all ages examined, air-exposure stress experienced at 7 dpf was particularly effective at eliciting phenotypic changes, suggesting a critical window at this age for a stress response to influence development. These findings demonstrate that early-life stress in zebrafish triggers developmental plasticity, with age-dependent effects on both the cortisol stress axis and ion balance.

Programmed ribosomal frameshifting (PRF) is a fundamental gene expression event in many viruses, including SARS-CoV-2. It allows production of essential viral, structural and replicative enzymes that are encoded in an alternative reading frame. Despite the importance of PRF for the viral life cycle, it is still largely unknown how and to what extent cellular factors alter mechanical properties of frameshift elements and thereby impact virulence. This prompted us to comprehensively dissect the interplay between the SARS-CoV-2 frameshift element and the host proteome. We reveal that the short isoform of the zinc-finger antiviral protein (ZAP-S) is a direct regulator of PRF in SARS-CoV-2 infected cells. ZAP-S overexpression strongly impairs frameshifting and inhibits viral replication. Using in vitro ensemble and single-molecule techniques, we further demonstrate that ZAP-S directly interacts with the SARS-CoV-2 RNA and interferes with the folding of the frameshift RNA element. Together, these data identify ZAP-S as a host-encoded inhibitor of SARS-CoV-2 frameshifting and expand our understanding of RNA-based gene regulation., Programmed ribosomal frameshifting (PRF) occurs in many viruses including SARS-CoV-2 to allow the translation of multiple proteins from a single transcript. Here, the authors identify the human short isoform of the zinc-finger antiviral protein (ZAP-S) as a direct regulator of PRF in SARS-CoV-2 that severely impairs SARS-CoV-2 frameshifting in cells and directly interacts with the SARS-CoV-2 RNA; interfering with the folding of the frameshift RNA element.

BACKGROUND: Health disparities exist in HIV risk in the USA among the lesbian-gay-bisexual-transgender-queer (LGBTQ) community. There is also scarce literature on curricula for HIV prevention and pre-exposure prophylaxis (PrEP) for trainees. AIM: To create a curriculum to train residents to perform inclusive sexual history taking and HIV prevention care. The curriculum covers sexual history, LGBTQ health, sexually transmitted infections, and HIV risk assessment and risk reduction counseling including use of PrEP. SETTING: A dedicated PrEP Clinic was created within an Academic Medical Center Outpatient HIV Clinic. Patients were primarily LGBTQ identified, but also included HIV sero-discordant couples, cisgender individuals, heterosexual invididuals, and those with experience of homelessness, sex work, and substance abuse. PARTICIPANTS: Thirty-four internal medicine residents completed the course between November 2017 and May 2018. PROGRAM DESCRIPTION: The curriculum was delivered as Just in Time Teaching (JiTT) via online virtual patient cases followed by directly observed clinical care at a large urban PrEP clinic. PROGRAM EVALUATION AND RESULTS: The effectiveness of the curriculum was assessed through paired pre/post-self-assessment surveys (n = 19), additional post-surveys on the online modules (n = 22), and interviews (n = 9). Many respondents reported no prior training or inadequate prior training in the course content. As a result of the course, participants reported statistically significant increased confidence and comfort in all seven HIV prevention topic areas, with the greatest gains in safe sex counseling for LGBTQ patients and in discussing PrEP (mean changes of 1.21, 1.58 on 5-point Likert scale, respectively, p

High β-glucan content is one of the main goals of oat breeding programs worldwide. However, the genomic regions and genes controlling β-glucan content in oats are not fully understood. In this sense, the objectives of this study were as follows: (i) to characterize structure and linkage disequilibrium (LD) in a panel of oat germplasm adapted to subtropical environments; and (ii) to identify genomic regions associated with oat β-glucan content. An oat panel with 413 genotypes was evaluated for β-glucan content under subtropical conditions in different years and genotyped using genotyping-by-sequencing. Population structure, LD, and genome-wide association (GWA) analyses were carried out. GWA mapping was performed for each year separately and in a multi-environment model. The UFRGS Oat Panel showed weak population structure and has great potential to elucidate many agronomic traits in subtropical environments. Seven quantitative trait loci (QTL) associated with β-glucan content were identified. These QTL are located on Mrg02, Mrg06, Mrg11, Mrg12, Mrg19, and Mrg20. The QTL located on Mrg02, Mrg06, and Mrg11 seem to be genomic regions syntenic with barley. The use of these QTL may be useful to accelerate the genetic progress of oat β-glucan content in subtropical environments.

The Cellulose synthase-like F6 (CslF6) gene has been reported as a key factor for β-glucan synthesis in grasses. However, the action of this gene on oat β-glucan content is poorly understood. The objectives of this study were: (i) to quantify the absolute expression of CslF6 transcripts in oats under field conditions; and (ii) to characterize the CslF6 homoeologs in oat genotypes with different levels of β-glucan content. Developing kernels of five oat genotypes were collected under field conditions in two planting dates. The CslF6 absolute quantification was performed using droplet digital PCR considering global and homoeolog-specific expressions. The third exon of the CslF6 gene, which covers approximately 62.2% of the coding region, was sequenced in each homoeolog. The CslF6 expression was highly influenced by planting date, kernel developmental stage, and genotype. High CslF6 transcript number was not associated with high β-glucan content, indicating the action of a complex biosynthesis pathway controlling this trait in oats. Under stressful conditions, the CslF6 expression was more pronounced and associated with β-glucan content. The CslF6 motif has 1767 bases pair and is highly conserved between A and D homoeologs. Single nucleotide polymorphisms were not identified among the assessed genotypes, regardless of the homoeolog. The results presented in this study may contribute for a better understanding of the CslF6 influence on oat β-glucan content.

Killifish (Fundulus heteroclitus) has been extensively used as a model for ion regulation by euryhaline fishes. Na+ and Cl− dynamics have been well studied in killifish, but few studies have addressed that of Ca2+. Therefore, this study aimed to characterize Ca2+ fluxes in freshwater (FW) and seawater (SW)-acclimated killifish, their response to salinity transfer, and to elucidate the mechanisms of Ca2+ influx in FW and SW. SW killifish displayed a significantly higher Ca2+ influx rate than that of FW fish, while Ca2+ efflux rates were comparable in both salinities. Ca2+ influx was saturable in FW (Km = 78 ± 19 µmol/L; Jmax = 53 ± 3 nmol/g/h) and influx by SW killifish was linear up to 7 mmol/L Ca2+. In SW-acclimated fish, 36% of Ca2+ influx was attributed to “intestinal Ca2+ intake”, likely caused by drinking, whereas intestinal Ca2+ intake in FW contributed to

This paper uses micro-level data from the Medical Expenditure Panel Survey to investigate whether, following the expiration of Lipitor’s patent, demand for Crestor shrank. The topic holds important policy implications owing to rapidly growing drug spending, because aggregate drug spending could potentially be reduced if insurers introduced incentives that encouraged patients to switch away from name-brand drugs, like Crestor, toward cheaper generic competitors. This paper produces several findings. The expiration of Lipitor’s patent does not appear to have significantly affected the overall market for Crestor. However, patients enrolled in private insurance do appear to have reduced Crestor usage by about 13%. Medicaid patients who used Crestor prior to the change in Lipitor’s patent status also appear to have reduced their Crestor usage by a relatively sizable amount. Finally, the expiration of Lipitor’s patent appears to have resulted in an 18% increase in the strength of a typical Crestor pill, which might be interpreted as a de facto price decrease for Crestor.

This paper investigates the effects of participation in gifted education programs, and offers several contributions to existing research. First, this paper studies the effects of high school programs, as opposed to the more commonly-studied elementary and middle school versions. Second, this paper considers impacts of gifted programs on later-in-life socioeconomic success, including college graduation and eventual employment, as opposed to short-run standardized test outcomes. Third, this paper uses sibling fixed effects, coupled with a recently-proposed decomposition method, as an identification approach. The main conclusion is that gifted programs tend to include students who possess traits that already correlate with later-in-life success. After controlling for those traits, gifted programs, per se, show little statistical relationship to later-in-life outcomes.

A 2010 national policy change due to the Affordable Care Act allowed dependent children to remain on parental health insurance policies until age 26. Evidence shows the mandate increased insurance coverage among affected young adults and also increased premiums for family health insurance policies. In this paper, we investigate the use of dependent tax exemptions as a mechanism families could use to pay for increased costs associated with expanded coverage. Using data on households from the Medical Expenditure Panel Survey, we use a difference-in-difference methodology comparing changes in the likelihood of being claimed as a dependent on a tax return for the 19–25 year olds affected by the coverage mandate compared to 16–18 year olds that were unaffected. We find a significant increase in dependent tax exemptions among 19–25 year olds following implementation of the dependent coverage mandate. Family income gains from switching an exemption from a young adult child to the parent would shift a substantial portion of young adult insurance coverage costs (ultimately medical costs) to other taxpayers. Though we point to family health insurance cost as a likely driver of the increased dependent tax exemptions, we cannot rule out a role for other outcomes also affected by the mandate, including labor market changes among 19–25 year olds. We further compare the overall social costs and benefits of the mandate and show that absent significant health improvement to date, welfare gains likely depend on the positive contribution of young adults to insurance pools in terms of lower average costs.

Copper (Cu) is a persistent environmental contaminant that elicits several physiological disturbances in aquatic organisms, including a disruption in ammonia regulation. We hypothesized that exposure to Cu in a model crustacean (blue crab, Callinectes sapidus) acclimated to brackish water (2 ppt) would lead to hyperammonemia by stimulating an increase in ammonia production and/or by inhibiting ammonia excretion. We further hypothesized that urea production would represent an ammonia detoxification strategy in response to Cu. In a pilot experiment, exposure to 0, 100, and 200 µg/L Cu for 6 h caused significant concentration-dependent increases in ammonia excretion (J amm). Based on these results, an acute 24-h 100 µg/L Cu exposure was conducted and this similarly caused an overall stimulation of J amm during the 24-h period, indicative of an increase in ammonia production. Terminal haemolymph total ammonia content (T amm) was unchanged, suggesting that while ammonia production was increased, there was no inhibition of the excretion mechanism. In support of our second hypothesis, urea excretion (J urea) increased in response to Cu exposure; haemolymph [urea] was unaffected. This suggested that urea production also was increased. To further test the hypothesis that J urea increased to prevent hyperammonemia during Cu exposure, crabs were exposed to high environmental ammonia (HEA; 2.5 mmol/L NH4HCO3) for 12 h in a separate experiment. This led to a fourfold increase in haemolymph T amm, whereas J urea increased only transiently and haemolymph [urea] was unchanged, indicating that urea production likely does not contribute to the attenuation of hyperammonemia in blue crabs. Overall, Cu exposure in blue crabs led to increased ammonia and urea production, which were both eliminated by excretion. These results may have important implications in aquaculture systems where crabs may be exposed to elevated Cu and/or ammonia.

Prostate epithelial cells control the potency and availability of androgen hormones in part by inactivation and elimination. UDP-glucose dehydrogenase (UGDH) catalyzes the NAD(+)-dependent oxidation of UDP-glucose to UDP-glucuronate, an essential precursor for androgen inactivation by the prostate glucuronidation enzymes UGT2B15 and UGT2B17. UGDH expression is androgen stimulated, which increases the production of UDP-glucuronate and fuels UGT-catalyzed glucuronidation. In this study, we compared the glucuronidation potential and its impact on androgen-mediated gene expression in an isogenic LNCaP model for androgen-dependent versus castration-resistant prostate cancer. Despite significantly lower androgen-glucuronide output, LNCaP 81 castration-resistant tumor cells expressed higher levels of UGDH, UGT2B15, and UGT2B17. However, the magnitude of androgen-activated UGDH and prostate-specific antigen (PSA) expression, as well as the androgen receptor (AR)-dependent repression of UGT2B15 and UGT2B17, was blunted several-fold in these cells. Consistent with these results, the ligand-activated binding of AR to the PSA promoter and subsequent transcriptional activation were also significantly reduced in castration-resistant cells. Analysis of the UDP-sugar pools and flux through pathways downstream of UDP-glucuronate production revealed that these glucuronidation precursor metabolites were channeled through proteoglycan and glycosaminoglycan biosynthetic pathways, leading to increased surface expression of Notch1. Knockdown of UGDH diminished Notch1 and increased glucuronide output. Overall, these results support a model in which the aberrant partitioning of UDP-glucuronate and other UDP-sugars into alternative pathways during androgen deprivation contributes to the loss of prostate tumor cell androgen sensitivity by promoting altered cell surface proteoglycan expression.

Der Hauptvorteil der wirtschaftlichen Herstellbarkeit bewahrter Verzahnungsprofile, wie beispielsweise der Evolvente, gerat in Zeiten der softwareunterstutzten Auslegung und Fertigung immer mehr in den Hintergrund. Die Verzahnungstechnik hat heute einen Standard erreicht, der es ermoglicht, einfache aber auch komplexe Verzahnungen flexibel und kostengunstig herzustellen. Insbesondere bei Sonderverzahnungen gewahrleisten moderne Fertigungsmethoden dem Anwender hochste Genauigkeiten fur Flankenform und Laufverhalten. Je nach Anwendungskontext haben unterschiedliche Verzahnungstypen Vor- und Nachteile bezuglich Tragfahigkeit, Wirkungsgrad oder Gerauschverhalten. Die Entwicklung einer dem gewunschten Einsatzbereich entsprechenden, optimalen Verzahnung stellt somit eine komplexe und elementare Aufgabe bei der Auslegung dar. Vor diesem Hintergrund stellt dieser Beitrag einen mathematischen Beschreibungsrahmen vor, der es erlaubt, die dreidimensionale Zahngeometrie von Zahnformen aller Art auf Basis des raumlichen Verzahnungsgesetzes zu berechnen. Die Bewertung des Eingriffsverhaltens wird mit einer lastlosen Zahnkontaktanalyse vollzogen, um charakteristische Grosen des Zahneingriffs wie Klaffmase, Tragbild, Beruhrlinien und Drehwegfehler zu ermitteln. Die einheitliche Geometrieberechnung unterstutzt den Ingenieur somit von Grund auf bei der Entwicklung neuartiger, je nach Anwendungsfall optimierter Verzahnungsprofile.

Background Although the status of women in anesthesiology has advanced by many measures, obtaining career development funding remains challenging. Here, we sought to compare the characteristics of funded career development awards from the National Institutes of Health (NIH) between the specialties of anesthesiology and surgery. We hypothesized that the two groups differ in percentage of faculty with awards, gender distribution among principal investigators, as well as the number of awards promoting diversity. Methods The NIH grant-funding database RePORT was queried for career development awards for the years 2006–2016 using the filters “Anesthesiology” and “Surgery.” Grants were characterized based on the gender of the principal investigator and whether the funding opportunity announcement indicated promotion of underrepresented minorities (URM). The 2016 Association of American Medical Colleges (AAMC) report on “Distribution of U.S. Medical School Faculty by Sex and Rank” was used to adjust comparisons according to baseline gender distributions in anesthesiology and surgery departments. Cohorts were characterized using descriptive methods and compared using Chi-square or Fisher’s exact test. Results Based on our AAMC data query, in 2016, the number of women faculty members at the instructor or assistant professor level in U.S. medical schools was 2314 (41%) for anesthesiology and 2281 (30%) for surgery. Between 2006 and 2016, there were 88 career development grants awarded to investigators in anesthesiology departments compared to 261 in surgery departments. Of the grantees in each specialty, 29 (33%) were women in anesthesiology and 72 (28%) in surgery (P = 0.344). Awards to promote URM were identified for two grants (2%) in anesthesiology and nine grants (3%) in surgery (P = 0.737). Faculty members in surgery were more likely to receive an award than in anesthesiology (P

Selection of oat genotypes combining earliness and short plant height could stimulate oat cultivation worldwide. However, the mechanisms involved with the genetic control of heading date and plant height traits are not fully understood to date. This study aimed to identify genomic regions controlling heading date and plant height in two hulled by naked oat populations and to compare these genomic regions with that of other grass species. Recombinant inbred lines of each population and their parents were genotyped by a 6 K BeadChip Illumina Infinium array and assessed for heading date and plant height in two sowing dates. The quantitative trait loci (QTL) affecting these traits were detected by simple interval mapping. The two oat populations showed different genetic mechanisms controlling heading date. A major QTL was identified in one of the populations, mapped into the ‘Mrg33’ consensus linkage group from the current oat map. Two other QTL were detected into the ‘Mrg02’ and ‘Mrg24’ groups, in the second population. On the other hand, both populations presented the same genomic region controlling plant height. Six SNP markers, mapping on the same linkage group within each population, were associated with the trait, regardless the sowing date, explaining more than 20% of the phenotypic variation. Five of these six markers were mapped into three different linkage groups on the oat consensus map. Genomic regions associated with heading date and plant height in oat seem to be conserved in Oryza sativa L. and Brachypodium distachyon. Our results provide valuable information for marker-assisted selection in oats, allowing selection for earliness and plant height on early segregating generations.

Hintergrund Verschiedene Publikationen beleuchteten bereits die Themen Patientensicherheit, Kommunikation und Fehlermanagement in Hinblick auf den einzelnen Rettungsassistenten. Doch welche Ansichten in Bezug auf diese Bereiche herrschen im mittleren Management der Leistungserbringer im hessischen Rettungsdienst vor?

This paper models co-movements in house prices using a copula-based approach that allows for asymmetric contemporaneous and dynamic dependence between prices in different locations. The models consider both US co-movements across different census divisions and international co-movements across different OECD countries. Results show evidence of strong contemporaneous tail dependence among US census divisions, indicating that extreme price movements in different areas tend to happen in tandem. On the international level, by contrast, results find almost no evidence of contemporaneous or dynamic linkages in house price movements between different countries. These results hold important implications for informing upon risk embedded in mortgage backed securities.

In the wake of the housing crisis, credit rating agencies have received much blame, particularly for the statistical tools they used to measure correlations in housing prices in different locations. Several studies have proposed alternative statistical models, but to date, all such approaches assume that correlations remain constant over time. This paper argues that, regardless of the correlation patterns built into such statistical models, correlations might strengthen during times of financial turmoil. Consequently, mortgage-backed securities might have been appropriately diversified during “ normal” times, but less so during extreme market swings. Using monthly data on housing prices in four major U.S. cities, the main findings confirm that housing prices do, indeed, exhibit correlations that change over time, and more importantly, those correlations appear to strengthen in the midst of market turmoil.

In den letzten Jahren wurden vielfaltige wissenschaftliche Betrachtungen zum Themenkomplex Patientensicherheit im Rettungsdienst veroffentlicht. Jedoch besteht die Frage, wie erleben Rettungsassistenten dieses Thema und welches Wissen besteht hierzu aktuell? 117 von 200 Rettungsassistenten der Stadt Frankfurt am Main nahmen an einer anonymen Umfrage teil. 76,9 % der Teilnehmer hatten ein groses bzw. sehr groses Interesse an der Patientensicherheit. 50,9 % beeintrachtigten bereits mindestens einmal den Zustand eines Patienten durch ihre Arbeit. 15,8 % vergessen oft bzw. sehr oft Informationen bei Ubergabegesprachen. 23,9 % hielten Notarzte fur schlechte Teamspieler. 96,5 % konnten in irgendeiner Form offen uber Fehler sprechen. 81 % wurden an einem Training teilnehmen, um die Patientensicherheit zu erhohen. Fur Rettungsassistenten scheint die unterschwellige Gefahrdung der Patientensicherheit zum Dienstalltag zugehoren. Durch bedarfsgerechte Aus- und Fortbildungen sollte das bestehende Interesse genutzt werden, um die Patientensicherheit zu erhohen. Im Vordergrund sollten das Arbeiten im Team, Kommunikation und Umgang mit Fehlern stehen.

Recent molecular evidence points towards a capacity for ammonia transport across the skin of adult rainbow trout. A series of in vivo and in vitro experiments were conducted to understand the role of cutaneous ammonia excretion (J amm) under control conditions and after 12-h pre-exposure to high environmental ammonia (HEA; 2 mmol/l NH4HCO3). Divided chamber experiments with bladder-catheterized, rectally ligated fish under light anesthesia were performed to separate cutaneous J amm from branchial, renal, and intestinal J amm. Under control conditions, cutaneous J amm accounted for 4.5 % of total J amm in vivo. In fish pre-exposed to HEA, plasma total ammonia concentration increased 20-fold to approximately 1,000 μmol/l, branchial J amm increased 1.5- to 2.7-fold, and urinary J amm increased about 7-fold. Urinary J amm still accounted for less than 2 % of total J amm. Cutaneous J amm increased 4-fold yet amounted to only 5.7 % of total J amm in these fish. Genes (Rhcg1, Rhcg2, Rhbg, NHE-2, v-type H+-ATPase) known to be involved in ammonia excretion at the gills of trout were all expressed at the mRNA level in the skin, but their expression did not increase with HEA pre-exposure. In vitro analyses using [14C] methylamine (MA), an ammonia analog which is transported by Rh proteins, demonstrated that MA permeability in isolated skin sections was higher in HEA pre-exposed fish than in control fish. The addition of basolateral ammonia (1,000 μmol/l) to this system abolished this increase in permeability, suggesting ammonia competition with MA for Rh-mediated transport across the skin of HEA pre-exposed trout; this did not occur in skin sections from control trout. Moreover, in vitro J amm by the skin of fish which had been pre-exposed to HEA was also higher than in control fish in the absence of basolateral ammonia, pointing towards a possible cutaneous ammonia loading in response to HEA. In vitro MA permeability was reduced upon the addition of amiloride (10−4 mol/l), but not phenamil (10−5 mol/l) suggesting a role for a Na/H-exchanger (NHE) in cutaneous ammonia transport, as has been previously described in the skin of larval fish. Overall, it appears that under control conditions and in response to HEA pre-exposure, the skin makes only a very minor contribution to total J amm, but the observed increases in cutaneous J amm in vivo and in cutaneous J amm and MA permeability in vitro demonstrate the capacity for ammonia transport in the skin of adult trout. It remains unclear if this capacity may become significant under certain environmental challenges or if it is merely a remnant of cutaneous transport capacity from early life stages in these fish.

Glassy nuclear fallout debris from near-surface nuclear tests is fundamentally reprocessed earth material. A geochemical approach to analysis of glassy fallout is uniquely suited to determine the means of reprocessing and shed light on the mechanisms of fallout formation. An improved understanding of fallout formation is of interest both for its potential to guide post-detonation nuclear forensic investigations and in the context of possible affinities between glassy debris and other glasses generated by high-energy natural events, such as meteorite impacts and lightning strikes. This study presents a large major-element compositional dataset for glasses within aerodynamic fallout from the Trinity nuclear test (“trinitite”) and a geochemically based analysis of the glass compositional trends. Silica-rich and alkali-rich trinitite glasses show compositions and textures consistent with formation through melting of individual mineral grains—quartz and alkali feldspar, respectively—from the test-site sediment. The volumetrically dominant glass phase—called the CaMgFe glass—shows extreme major-element compositional variability. Compositional trends in the CaMgFe glass are most consistent with formation through volatility-controlled condensation from compositionally heterogeneous plasma. Radioactivity occurs only in CaMgFe glass, indicating that co-condensation of evaporated bulk ground material and trace device material was the main mechanism of radioisotope incorporation into trinitite. CaMgFe trinitite glasses overlap compositionally with basalts, rhyolites, fulgurites, tektites, and microtektites but display greater compositional diversity than all of these naturally formed glasses. Indeed, the most refractory CaMgFe glasses compositionally resemble early solar system condensates—specifically, CAIs.

We conducted an observational study to assess the hypothesis that the pelvic muscles actively open the anorectal lumen during defecation. Three groups of female patients were evaluated with video imaging studies of defecation using a grid or bony reference points. Eight patients with idiopathic fecal incontinence had video myogram defecography; eight with obstructive defecation had magnetic resonance imaging (MRI) defecating proctograms; and four normal patients had video X-ray or MRI defecating proctogram studies. In all three groups, the anorectum was stretched bidirectionally by three directional muscle force vectors acting on the walls of the rectum, effectively doubling the diameter of the rectum during defecation. The anterior rectal wall was pulled forwards, and the posterior wall backwards and downwards opening the anorectal angle, associated with angulation of the anterior tip of the levator plate (LP). These observations are consistent with a staged relaxation of some parts of the pelvic floor during defecation, and contraction of others. First, the puborectalis muscle relaxes. Puborectalis muscle relaxation frees the posterior rectal wall so that it can be stretched and opened by contraction of the LP and conjoint longitudinal muscle of the anus. Second, contraction of the pubococcygeus muscle pulls forward the anterior rectal wall, further increasing the diameter of the rectum. Third, when the bolus has entered the rectum, the external anal sphincter relaxes, and the rectum contracts to expel the fecal bolus. Our results are consistent with the hypothesis that pelvic striated muscle actively opens the rectal lumen, thereby reducing internal anorectal resistance to expulsion of feces. Controlled studies of electromyographic activity would be useful to further test this hypothesis.

Consisting of ∼1014 microbial cells, the intestinal microbiota represents the largest and the most complex microbial community inhabiting the human body. However, the influence of regular diets on the microbiota is widely unknown. We examined faecal samples of vegetarians (n=144), vegans (n=105) and an equal number of control subjects consuming ordinary omnivorous diet who were matched for age and gender. We used classical bacteriological isolation, identification and enumeration of the main anaerobic and aerobic bacterial genera and computed absolute and relative numbers that were compared between groups. Total counts of Bacteroides spp., Bifidobacterium spp., Escherichia coli and Enterobacteriaceae spp. were significantly lower (P=0.001, P=0.002, P=0.006 and P=0.008, respectively) in vegan samples than in controls, whereas others (E. coli biovars, Klebsiella spp., Enterobacter spp., other Enterobacteriaceae, Enterococcus spp., Lactobacillus spp., Citrobacter spp. and Clostridium spp.) were not. Subjects on a vegetarian diet ranked between vegans and controls. The total microbial count did not differ between the groups. In addition, subjects on a vegan or vegetarian diet showed significantly (P=0.0001) lower stool pH than did controls, and stool pH and counts of E. coli and Enterobacteriaceae were significantly correlated across all subgroups. Maintaining a strict vegan or vegetarian diet results in a significant shift in the microbiota while total cell numbers remain unaltered.

The State Children’s Health Insurance Program (SCHIP) of 1997 aimed to increase public insurance eligibility to children in families that were above the Medicaid income cutoff line, but were too poor to afford private coverage. This paper shows that SCHIP helped as many as 1.3 million children leave the ranks of the uninsured. However, almost 400,000 of these children came from families with two privately insured parents, and added approximately $300 million in health care expenses to federal and state budgets. This paper also presents estimates of health care consumption of children who switched to public insurance as a result of SCHIP.

Kommunikation ist von herausragender Bedeutung in der Notfallmedizin. Wir entwickelten und untersuchten den Einfluss einer einfachen Schulung auf die Kommunikation in einem Rettungsdienstteam und die Patientenubergabe an den Notarzt. Vier Szenarien und zwei Analysewerkzeuge wurden zur Bewertung von simulierten Notfalleinsatzen entwickelt. Zunachst wurden 20 Einsatze an diesem Simulationsmodell durchgefuhrt, negative Kommunikationsereignisse (NKE) registriert und auf Basis dieser Ergebnisse eine dreistundige Schulung entwickelt. Diese beinhaltete Hintergrundwissen, funf Kommunikationsregeln und das Patientenubergabe-Schema nach Bestand, Anamnese, Untersuchung und Masnahmen (BAUM-Schema). Nach einer solchen Schulung wurden von anderen Rettungsdienstteams weitere 20 Einsatze durchgefuhrt und ausgewertet. Die Anzahl der NKE vor der Schulung betrug 3,9 pro Szenario (95%-Konfidenzintervall, 95%-KI: 3,1–4,7). Durch Anwendung der Schulung von funf Kommunikationsregeln konnte die Anzahl der NKE auf 1,8 (95%-KI: 1,2–2,4) vermindert werden. Die Anwendung des BAUM-Schemas steigerte die Anzahl der Informationseinheiten an den Notarzt durchschnittlich von 53,7% auf 61,7% (p=0,038). Die Kommunikationsschulung und das BAUM-Schema konnen sich zur Strukturierung des Kommunikationsverhaltens und zur Verbesserung der Patientenubergabe von Rettungsassistenten eignen und wurden sich damit zur Qualitatsverbesserung in der Notfallmedizin anbieten.

This paper investigates the various insurance options that are available to self-employed workers, including nongroup individual plans that have been the focus of policy reforms during the past decade. Estimates of health care demand models seek to determine whether these options relate to spending on and usage of physician services and prescription drugs as well as total medical expenses. Results based on 1996–2005 Medical Expenditure Panel Survey data indicate that individual enrollees spend less than group enrollees, but models that attempt to purge endogeneity bias suggest that this difference does not depend on insurance per se. Rather, those who enroll in individual plans possess unmeasured traits associated with lower health care demand.

Although evidence of a link between socioeconomic status and child health has been researched extensively, much less attention has been devoted to studying the link between child health and cognitive development. This paper seeks to determine whether early childhood illnesses and poverty significantly impede cognitive development. The empirical model attempts to control for observed and unobserved heterogeneity through the use of panel data models. Results indicate that a child’s cognitive development is not directly related to health problems acquired after birth or socioeconomic standing. Rather, cognitive development is primarily influenced by unobserved child- and family-specific factors that happen to be correlated with health and socioeconomic status. On the other hand, birth weight appears to affect cognitive performance later in childhood, even after taking unobserved heterogeneity into account.

Data from the Medical Expenditure Panel Survey indicate that for couples in which both spouses are employed, 36% of privately insured couples are characterized by an arrangement in which the husband and wife are enrolled in separate plans. This paper empirically investigates several aspects of spouses’ decisions to enroll in separate insurance plans. Results indicate that each spouse’s probability of being offered employer-provided insurance is related to the probability that his or her partner is also offered employer-provided insurance. Furthermore, married couples appear to pay for various insurance arrangements through lower wage earnings.

Eine 49-jahrige Frau wurde bei zunehmender Luftnot, bedingt durch eine massive Weichteilschwellung des Halses und des Gesichtes, sowie einer ausgepragten Makroglossie auf die Intensivstation ubernommen. Bei der Patientin und deren Vater waren schon fruher ahnliche Symptome beobachtet worden, die aber niemals so dramatisch gewesen waren. Die Patientin wurde bronchoskopisch intubiert und mit Kortison, Frischplasma und C1-Esterase-Inhibitor ohne Erfolg behandelt. Erst mehrere Tage nach dem Akutereignis konnte sie von der Einnahme eines Angiotensinkonversionsenzym- (ACE-)Hemmers berichten, der bei nahezu normalen C1- und C4-Komplementfaktoren im Serum mit groser Wahrscheinlichkeit das auslosende Agens war.

This paper investigates the extent to which child health affects maternal work activity. Estimating this causal relationship is complicated because unobserved heterogeneity that affects a child’s health might also affect the mother’s labor market attachment. Using variables that measure a family’s access to care as instruments, the main finding of this paper is that child health does not appear to be a significant determinant of maternal employment.

Neisseria meningitidis (meningococcus), an exclusive pathogen of humans, is the cause of sepsis (meningococcemia) and meningitis, often in otherwise healthy individuals. Several hundred thousand cases of meningococcal disease occur worldwide each year, a number that is frequently accentuated by epidemic outbreaks. In recent years, significant advances, fueled by new molecular approaches and genome sequencing projects, have improved our understanding of the pathogenesis of meningococcal disease and have led to progress in the development of the next generation of meningococcal vaccines. However, the mortality of meningococcal disease remains 10% to 15% for all cases, and is up to 40% in patients with severe sepsis. This review summarizes current knowledge of the pathogenesis, therapy, and prevention of meningococcal disease with emphasis on meningococcal sepsis.

Precise and specific methods for the simultaneous quantitative determination of lignin and cellulose are discussed in this paper, enabling the monitoring of even slight changes in the content of lignocellulose in dead plant material during decomposition processes. Results from different leaf litter samples as well as a comparison of the lignocellulose content of freshly fallen leaf litter, leached and microbially inoculated leaf litter, and feces of saprophagous soil animals fed on this food source are presented. The suitability of the described methods for investigating decomposition processes is discussed.

Gorlin (or nevoid basal cell carcinoma) syndrome is characterized by a variety of clinical problems including generalized overgrowth of the body, cysts, developmental abnormalities of the skeleton and a predisposition to benign and malignant tumors. The syndrome results from germline mutations of the human homolog of the drosophila segment polarity gene patched (ptc). Here we report that mice heterozygous for ptc develop many of the features characteristic of Gorlin syndrome and that they exhibit a high incidence of rhabdomyosarcomas (RMS), the most common soft-tissue sarcoma in children. The downstream signalling partner of ptc, gli1, was overexpressed in all RMSs analyzed, indicating that abnormal signalling of the ptc-gli1 pathway may be common for the various tumors associated with the syndrome. igf2, implicated in the formation of RMSs, was also overexpressed, suggesting cross-talk between the ptc and igf2 pathways in tumorigenesis. Developmental defects in Gorlin syndrome resemble those induced by ionizing radiation. We show that ptc heterozygous mice exhibit increased incidence of radiation-induced teratogenesis. This suggests a role for ptc in the response to ionizing radiation and provides a model for both the systemic (developmental) and stochastic (cancer) abnormalities observed in Gorlin syndrome.

Tyrosine kinase growth factor receptors and Ras/Raf/MEK/MAPK signalling have been implicated in the suppression1–3 as well as augmentation of programmed cell death4. In addition, a Ras-independent role for Raf as a suppressor of programmed cell death has been suggested by the recent finding that Craf1 interacts with members of the Bcl-2 family at mitochondrial membranes5. However, genetic studies of C elegans6 and Drosophila7, as well as the targeted mutagenesis of the murine Araf gene8, have failed to support such a role. Here we show that mice with a targeted disruption in the Braf gene die of vascular defects during mid-gestation. Braf−/− embryos, unlike Araf−/−8 or Craf1−/− embryos (L.W. et al., unpublished), show an increased number of endothelial precursor cells, dramatically enlarged blood vessels and apoptotic death of differentiated endothelial cells. These results establish Braf as a critical signalling factor in the formation of the vascular system and provide the first genetic evidence for an essential role of a Raf gene in the regulation of programmed cell death.

ENKEPHALINS are endogenous opioid peptides that are derived from a pre-proenkephalin precursor protein1,2. They are thought to be vital in regulating many physiological functions, including pain perception and analgesia, responses to stress, aggression and dominance3–5. Here we have used a genetic approach to study the role of the mammalian opioid system. We disrupted the pre-proenkephalin gene using homologous recombination in embryonic stem cells to generate enkephalin-deficient mice. Mutant enk−/− animals are healthy, fertile, and care for their offspring, but display significant behavioural abnormalities. Mice with the enk−/− genotype are more anxious and males display increased offensive aggressiveness. Mutant animals show marked differences from controls in supraspinal, but not in spinal, responses to painful stimuli. Unexpectedly, enk−/− mice exhibit normal stress-induced analgesia. Our results show that enkephalins modulate responses to painful stimuli. Thus, genetic factors may contribute significantly to the experience of pain.

We present a new measurement of the total photoproduction cross section performed with the H1 detector at HERA. For an average centre of mass energy of 200 GeV a value of σtotλp=165±2±11µb has been obtained. A detailed analysis of the data in adequate kinematic regions enabled a decomposition of the total cross section in its elastic, single diffractive dissociation and remaining non-diffractive parts, based on safe assumptions on the double diffractive dissociation contribution.

We introduce a new general model for the simulation of dense macromolecular systems. It consists of basic ellipsoidally shaped units stringed together to form chains, including branched and side chains. The ellipsoidally shaped unit can vary in its principal axes, allowing for flexible modeling of a chain. The variation in the main principal axis is used for the intramolecular potential of the bond type. Intramolecular units interact through a harmonic bond-angle potential and the intermolecular interaction is modelled by a confocally decreasing Lennard-Jones potential. We present the model for the special case of a polycarbonate and indicate the generalization to other cases.

When a cement canal prosthesis is used as the femoral component in total hip replacement (THR), the penetration depth of the bone cement can be varied according to the cement implantation pressure. Using experimental data which give a relation between the pressure applied to the cement at implantation and the resulting shape of the cement layer, a three-dimensional finite element study was performed to calculate the stress distribution at the bone/bone cement interface. The calculations show that the interface stresses increase with increasing depth of penetration by the cement layer. The explanation of this effect is that as the bone cement penetrates further into the cancellous bone, the cancellous bone is stiffened and can no longer act as a soft interposition between cortical bone and bone cement. From these results and from the clinical requirement that as little bone as possible be destroyed in any kind of allo-arthroplasty, we conclude that the penetration depth of bone cement into cancellous bone in THR should be minimized to the depth necessary in order to achieve sufficient initial stability of the implant. The results show that a cement-canal prosthesis meets these requirements if a cement implantation pressure of 1.0 bar is used.

The reactionγγ→3π +3π - has been studied usig the JADE detector at PETRA. The topological cross sectionσ(γγ→3π +3π -) was measured in the CM energy range 1.5–5.5 GeV. The production ofρ 0,s was observed and the average number ofρ 0,s per event measured. The contributions of the subprocessesγγ→ρ 02π +2π -,γγ→ρ 0 ρ 0 π +2π - andγγ→ 3π +3π - (phase space) were studied and 95% C.L. upper limits for the cross sectionσ(γγ→ρ 0 ρ 0 π + π - determined. Finally the Bose-Einstein correlation for pairs of like signed pions was observed. A fit to a standard parametrization gave results consistent with other studies of this effect in pion systems.

The cross sections for 2-, 3- and 4-jet production have been determined with the JADE detector, sited on thee+e−-storage ring PETRA. Data at\(\sqrt s = 14\), 22, 35 and 44 GeV were compared to twoO(α s 2 ) QCD calculations. A first analysis was performed with uncorrected data using theO(α s 2 ) 3-jet matrix element calculation of Ellis, Ross and Terrano and the Lund String Monte Carlo program. In a second analysis the calculation of Kramer and Lampe was compared to corrected data. Both approaches gave a poor description of the data when the square of the momentum transferQ2=s was used as the scale of the running coupling constant. The description improved when the renormalization scale was adjusted to the process studied. The data ware used to fix the best renormalization scale.

The cross-sections and the forward-backward charge asymmetries of muon and tau pairs produced ine + e − collisions at $$\sqrt s = 35 GeV$$ have been measured by the JADE Collaboration. The cross-sections, $$\sigma _\mu (\sqrt s = GeV) = 69.79 \pm 1.35 \pm 1.40 pb$$ and $$\sigma _\mu (\sqrt s = GeV) = 71.72 \pm 1.48 \pm 1.61 pb$$ , are in agreement with the QED α3 prediction. The charge asymmetries areA μ=−(9.9±1.5±0.5)% andA τ=−(8.1±2.0±0.6)% in agreement with the value −9.2% predicted by the standard model, usingM Z=91.0 GeV and sin2θ W =0.230.

The reaction γγ→π+π-π+π-π0 has been studied using the JADE detector at PETRA. The cross sections for γγ→ωπ+- and for γγ→ωρ0- are given. We observe no peak in these cross sections in the regionWγγ=1.9–2.0 GeV.

Resonance production in the γγ reactionse+e−→e+e+e−π0π0 ande+e−π0η has been studied with the JADE detector at PETRA. The decay widths into γγ of thef2(1270),a0(980) anda2(1320) were measured to be\(\Gamma _{\gamma \gamma } (f_2 (1270)) = 3.19 \pm 0.09_{ - 0.38}^{ + 0.22} \) Kev,Γλλ(a0(980))=0.28±0.04±0.10 KeV/BR(a0(980)→π0η) andΓλλ(a2(1320))=1.01±0.14±0.22KeV. For thef0(975) andf4(2050) upper limits of the widths were obtained,Γλλ(f0(975))

The forward-backward charge asymmetries of theb andc quarks are measured with the JADE detector at PETRA at $$\sqrt s = 35$$ GeV and 44 GeV using both electrons and muons to tag the heavy quarks. At $$\sqrt s = 35$$ GeV, a simultaneous fit for the two asymmetries yields the resultA b =−9.3±5.2% (state.) ndA c =−9.6±4.0% (stat.). The systematic errors are comparable with the statistical uncertainties. Combining the measurements at both energies and alternately constraining the weak coupling of thec andb quark to their Standard Model values (a c =1,a b =−1) increases the precision of the measurement of coupling constant of the other quark. Using this procedurea b =−0.72±0.34 anda c =0.79±0.40, where the numbers are corrected for $$B\bar B - mixing$$ and the errors include both statistical and systematic contributions. The mixing parameter for continuum $$b\bar b - production$$ is determined to be χ-0.24±0.12 if both heavy quark coupling constants are constrained to their values in the Standard Model.

Results are presented on an investigation of photons produced in multihadronic final states frome+e− annihilation at 35 GeV and 44 GeV center of mass energies. Scalling violation between 14 and 44 GeV is observed in inclusive photon spectra. Comparing inclusive π0 spectra with charged pion spectra it is found that the average π0 multiplicity exceeds the charged pion multiplicity scaled by factor of 0.5 by (16±5)% and (21±7)% at 35 and 44 GeV respectively. The excess can be attributed to isospin violating decays of hadrons. The η multiplicity is found to be 〈nη〈=0.64±0.09±0.06 at 35 GeV. With a significance of three standard deviations a signal from quark bremsstrahlung is observed. The measured charge asymmetry in hadronic final states, due to the interference between initial and final state radiation, ofA=−0.141±0.041 is in accord with QED expectations. An interference effect in the azimuth angle distribution of charged jets around the photon direction is observed for the first time.

Background The homeopathic drug combination Lymphdiaral Basistropfen is established in the treatment of edema and swellings. This is the first time the effectiveness and safety was investigated in the treatment of chronic low back pain. Methods The study is a randomized, double-blind, placebo-controlled trial. From December 2003 to May 2007 248 patients aged 18 to 75 years were screened, 228 were randomized, 221 started therapy, in 192 the progress was measured (103 verum vs. 89 placebo), 137 completed the study (72 verum vs. 65 placebo). They received 10 drops of verum or placebo solution three times daily for 105 days additionally to an inpatient complex naturopathic treatment. Results The hannover functional ability questionnaire score (primary outcome measure) tends to increase in the intention-to-treat-analysis (verum: 6.6 vs. placebo: 3.4; p = 0.11) and increases significantly in the per-protocol-analysis (verum: 9.4 vs. placebo: 4.1; p = 0.029). The treatment was well tolerated (92.9% vs. 95.4%). The incidence of adverse reactions and serious adverse reactions was similar in both treatment groups. Conclusions This first randomized, double-blind, placebo-controlled trial shows, that the homeopathic drug combination can improve the treatment of chronic low back pain.

In studies on digestive processes and microorganisms in the gut of the common woodlouse, Porcellio scaber (Isopoda: Oniscidea), we observed marked contradictions between the activity of cellulolytic enzymes and the number of microorganisms. The anterior hindgut exhibited the highest cellulolytic activity, but was characterized by low microbial counts. Due to the presence of endosymbiotic bacteria in the midgut lobes that appear to produce cellulases, we suggest that the cellulases that are active in the hindgut of woodlice are of endogenous origin.